By Jonathan Jay, MD, Board Certified Urologist
Q: I had a sling for bladder control problems, six months ago, but I still have urinary leakage. What can I do?
A: Although technical or healing issues can play a role, other factors may have been involved with your leakage in the first place. A careful history and examination as well as computerized urodynamic tests and cystoscopy will help to determine if you have an underlying bladder condition. Technical issues related to the sling procedure can also be determined and often a minor adjustment of the sling, addition of a medication, local injection of a urethral bulking agent or even Botox will resolve such a problem.
Q: I have a dropped bladder (vaginal prolapse) and I don’t want vaginal mesh. Is there another option?
A: Vaginal prolapse can be treated in a number of ways without requiring synthetic mesh material. Depending upon the type of defect you have the pelvic ligaments may be restored using sutures to re-establish their original position. There are also other biologic graft options that can be used in place of synthetic mesh. These corrective surgeries are minimally invasive and performed through either small vaginal incisions or robotically through tiny holes in the abdomen. There is usually minimal discomfort with these procedures and a relatively fast return to normal activities.
Q: I get up to urinate two to three times every night. I usually go right back to sleep, but sometimes I am tired the next day. Is this normal?
A: This condition is called nocturia and can be caused by a number of different issues. It is very common and considered normal for a person to get up once per night to urinate by age 70. This is because as the body ages it becomes slightly less efficient at eliminating fluid during the day. However, if you are needing to urinate two or more times per night, it could be due to problems such as an enlarged prostate or other prostate problem in men. In women this could be due to a fallen bladder or urethral problem. In either gender problems with the heart, blood pressure or even diabetes could be playing a roll. It is essential to evaluate the underlying causes for nocturia so that you have the option of treating the minor issues and the opportunity to catch something serious early. Tests such as a thorough medical history, physical exam, urinalysis, simple blood tests, computerized urodynamics, ultrasound of the kidneys and cystoscopy (also known as a fiberoptic examination of the bladder) can be extremely helpful in determining the cause and what can be done to correct nocturia. Treatments could be as simple as modifications in your diet or fluid intake to simple medications or over-the-counter supplements and even exercise. More serious conditions are always better dealt with when caught early. For more information or to schedule a consultation, visit www.specialistsinurology.com or call 239-434-6300.
Q: Why do I keep getting urinary tract infections?
A: Urinary tract infections (UTIs) are caused by bacteria that grow in any part of the urinary tract. The bladder is the most common site for a UTI. Frequent UTIs, 3 or more per year, are divided into persistent (one bacteria that doesn’t resolve with treatment) or recurrent (a separate infection, with the same or different bacteria, that has a period of resolution between infections). Causes for frequent UTIs include poor hygiene techniques, hormonal changes such as menopause, incontinence, kidney stones and intercourse to name a few. Some serious diseases, including bladder cancer, may mimic a urinary tract infection and should be ruled out by a qualified urologist before starting treatment for frequent UTIs.
Q: I’ve started to leak urine is this a normal part of ageing?
A: No, it is not a normal part of ageing but, unfortunately, may become more common as women age. Over 40 million women in the United States are believed to have some type of urinary leakage. There are two main types of leakage. Urge urinary incontinence which is when you have to rush to the bathroom and don’t make it in time and stress urinary incontinence which occurs with physical activity, cough or sneeze. It is most common in my practice to see women with a component of both which is a bit more complex to treat. The most important thing to know is that these conditions can be successfully treated and can vastly improve a person’s quality of life.